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Hypercoagulable State in Cushing’s Syndrome: A Systematic Review
Abstract
CONTEXT: It has been debated whether an increased risk of venous thromboembolism (VTE) exists in patients with Cushing's syndrome. OBJECTIVE: We aimed to summarize published literature on the effects of endogenous hypercortisolism on coagulation and fibrinolysis, as well as on the clinical outcome of VTE. DATA SOURCES: We searched the MEDLINE and EMBASE databases up to July 2008. Review of reference lists further identified candidate studies. STUDY SELECTION: Two investigators independently performed study selection and data extraction. Eligible studies had to include Cushing's syndrome patients and either evaluate hemostatic parameters in comparison with control persons or posttreatment levels or describe the occurrence of VTE. DATA EXTRACTION: The Newcastle-Ottawa Scale was used to assess study quality. A scoring system divided studies into categories of low, medium and high quality. DATA SYNTHESIS: Of 441 identified publications, 15 reports were included. They contained information on eight cross-sectionals, two intervention, and eight cohort studies. No high-quality studies were identified. Hypercoagulability was suggested by high levels of factor VIII, factor IX, and von Willebrand factor and by evidence of enhanced thrombin generation. A risk of 1.9 and 2.5% was reported for VTE not provoked by surgery, whereas risk of postoperative VTE varied between 0 and 5.6%, with one outlier of 20%. VTE was reported as the cause of death in 0-1.9% of Cushing's syndrome patients. CONCLUSIONS: Available studies suggest a high risk of venous thrombosis in patients with Cushing's syndrome. Glucocorticoid-induced hypercoagulability as well as surgery and obesity almost certainly contribute to this thrombotic tendency.
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“Finally, patients with active CS have a high risk of venous thromboembolism (VTE) in comparison to the general population (8, 45, 46).”
From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [45]
In the citing paper
“Cushing syndrome is associated with a high risk of venous thromboembolic events which can be a presenting symptom”
From Approach to the Patient: Diagnosis of Cushing Syndrome (2022) · cites this paper as [45]
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Metadata
- Authors
- Van Zaane, B., Nur, E., Squizzato, A., Dekkers, O. M., Twickler, M. (. B., Fliers, E., Gerdes, V. E. A., Büller, H. R., & Brandjes, D. P. M.
- Affiliations
- Slotervaartziekenhuis (NL)
- University of Insubria (IT)
- Leiden University Medical Center (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Department of Vascular Medicine (B.V.Z., A.S., M.B.T., V.E.A.G., H.R.B.), Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2009-08-01
- Volume
- 94
- Issue
- 8
- Pages
- 2743-2750
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2116856478
- Cited by
- 216
- References
- 68
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 13 · 2023: 17 · 2022: 15 · 2021: 13 · 2020: 12 · 2019: 10 · 2018: 7 · 2017: 11 · 2016: 11 · 2015: 19 · 2014: 15 · 2013: 12 · 2012: 21
- FWCI
- 2.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- IrInSubria (University of Insubria) (submittedVersion)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- Cushing's syndrome, hypercoagulability, venous thromboembolism, hypercortisolism, coagulation, fibrinolysis, factor VIII, factor IX, von Willebrand factor, thrombin generation, postoperative thrombosis, obesity, mortality
- MeSH terms
- Blood Coagulation, Cushing Syndrome, Fibrinolysis, Humans, Thrombophilia, Venous Thromboembolism
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